Lung recruitability is better estimated according to the Berlin definition of acute respiratory distress syndrome at standard 5 cm H2O rather than higher positive end-expiratory pressure: a retrospective cohort study

Pietro Caironi, Eleonora Carlesso, Massimo Cressoni, Davide Chiumello, Onner Moerer, Chiara Chiurazzi, Matteo Brioni, Nicola Bottino, Marco Lazzerini, Guillermo Bugedo, Michael Quintel, V. Marco Ranieri, Luciano Gattinoni

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: The Berlin definition of acute respiratory distress syndrome has introduced three classes of severity according to PaO2/FIO2 thresholds. The level of positive end-expiratory pressure applied may greatly affect PaO2/FIO2, thereby masking acute respiratory distress syndrome severity, which should reflect the underlying lung injury (lung edema and recruitability). We hypothesized that the assessment of acute respiratory distress syndrome severity at standardized low positive end-expiratory pressure may improve the association between the underlying lung injury, as detected by CT, and PaO2/FIO2-derived severity.

DESIGN: Retrospective analysis.

SETTING: Four university hospitals (Italy, Germany, and Chile).

PATIENTS: One hundred forty-eight patients with acute lung injury or acute respiratory distress syndrome according to the American-European Consensus Conference criteria.

INTERVENTIONS: Patients underwent a three-step ventilator protocol (at clinical, 5 cm H2O, or 15 cm H2O positive end-expiratory pressure). Whole-lung CT scans were obtained at 5 and 45 cm H2O airway pressure.

MEASUREMENTS AND MAIN RESULTS: Nine patients did not fulfill acute respiratory distress syndrome criteria of the novel Berlin definition. Patients were then classified according to PaO2/FIO2 assessed at clinical, 5 cm H2O, or 15 cm H2O positive end-expiratory pressure. At clinical positive end-expiratory pressure (11±3 cm H2O), patients with severe acute respiratory distress syndrome had a greater lung tissue weight and recruitability than patients with mild or moderate acute respiratory distress syndrome (p

CONCLUSIONS: The Berlin definition of acute respiratory distress syndrome assessed at 5 cm H2O allows a better evaluation of lung recruitability and edema than at higher positive end-expiratory pressure clinically set.

Original languageEnglish
Pages (from-to)781-790
Number of pages10
JournalCritical Care Medicine
Volume43
Issue number4
DOIs
Publication statusPublished - Apr 1 2015

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Positive-Pressure Respiration
Adult Respiratory Distress Syndrome
Berlin
Cohort Studies
Retrospective Studies
Lung
Lung Injury
Edema
Severe Acute Respiratory Syndrome
Acute Lung Injury
Chile
Mechanical Ventilators
Clinical Protocols
Italy
Germany
Pressure
Weights and Measures

ASJC Scopus subject areas

  • Medicine(all)

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Lung recruitability is better estimated according to the Berlin definition of acute respiratory distress syndrome at standard 5 cm H2O rather than higher positive end-expiratory pressure : a retrospective cohort study. / Caironi, Pietro; Carlesso, Eleonora; Cressoni, Massimo; Chiumello, Davide; Moerer, Onner; Chiurazzi, Chiara; Brioni, Matteo; Bottino, Nicola; Lazzerini, Marco; Bugedo, Guillermo; Quintel, Michael; Ranieri, V. Marco; Gattinoni, Luciano.

In: Critical Care Medicine, Vol. 43, No. 4, 01.04.2015, p. 781-790.

Research output: Contribution to journalArticle

Caironi, Pietro ; Carlesso, Eleonora ; Cressoni, Massimo ; Chiumello, Davide ; Moerer, Onner ; Chiurazzi, Chiara ; Brioni, Matteo ; Bottino, Nicola ; Lazzerini, Marco ; Bugedo, Guillermo ; Quintel, Michael ; Ranieri, V. Marco ; Gattinoni, Luciano. / Lung recruitability is better estimated according to the Berlin definition of acute respiratory distress syndrome at standard 5 cm H2O rather than higher positive end-expiratory pressure : a retrospective cohort study. In: Critical Care Medicine. 2015 ; Vol. 43, No. 4. pp. 781-790.
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T1 - Lung recruitability is better estimated according to the Berlin definition of acute respiratory distress syndrome at standard 5 cm H2O rather than higher positive end-expiratory pressure

T2 - a retrospective cohort study

AU - Caironi, Pietro

AU - Carlesso, Eleonora

AU - Cressoni, Massimo

AU - Chiumello, Davide

AU - Moerer, Onner

AU - Chiurazzi, Chiara

AU - Brioni, Matteo

AU - Bottino, Nicola

AU - Lazzerini, Marco

AU - Bugedo, Guillermo

AU - Quintel, Michael

AU - Ranieri, V. Marco

AU - Gattinoni, Luciano

PY - 2015/4/1

Y1 - 2015/4/1

N2 - OBJECTIVES: The Berlin definition of acute respiratory distress syndrome has introduced three classes of severity according to PaO2/FIO2 thresholds. The level of positive end-expiratory pressure applied may greatly affect PaO2/FIO2, thereby masking acute respiratory distress syndrome severity, which should reflect the underlying lung injury (lung edema and recruitability). We hypothesized that the assessment of acute respiratory distress syndrome severity at standardized low positive end-expiratory pressure may improve the association between the underlying lung injury, as detected by CT, and PaO2/FIO2-derived severity.DESIGN: Retrospective analysis.SETTING: Four university hospitals (Italy, Germany, and Chile).PATIENTS: One hundred forty-eight patients with acute lung injury or acute respiratory distress syndrome according to the American-European Consensus Conference criteria.INTERVENTIONS: Patients underwent a three-step ventilator protocol (at clinical, 5 cm H2O, or 15 cm H2O positive end-expiratory pressure). Whole-lung CT scans were obtained at 5 and 45 cm H2O airway pressure.MEASUREMENTS AND MAIN RESULTS: Nine patients did not fulfill acute respiratory distress syndrome criteria of the novel Berlin definition. Patients were then classified according to PaO2/FIO2 assessed at clinical, 5 cm H2O, or 15 cm H2O positive end-expiratory pressure. At clinical positive end-expiratory pressure (11±3 cm H2O), patients with severe acute respiratory distress syndrome had a greater lung tissue weight and recruitability than patients with mild or moderate acute respiratory distress syndrome (pCONCLUSIONS: The Berlin definition of acute respiratory distress syndrome assessed at 5 cm H2O allows a better evaluation of lung recruitability and edema than at higher positive end-expiratory pressure clinically set.

AB - OBJECTIVES: The Berlin definition of acute respiratory distress syndrome has introduced three classes of severity according to PaO2/FIO2 thresholds. The level of positive end-expiratory pressure applied may greatly affect PaO2/FIO2, thereby masking acute respiratory distress syndrome severity, which should reflect the underlying lung injury (lung edema and recruitability). We hypothesized that the assessment of acute respiratory distress syndrome severity at standardized low positive end-expiratory pressure may improve the association between the underlying lung injury, as detected by CT, and PaO2/FIO2-derived severity.DESIGN: Retrospective analysis.SETTING: Four university hospitals (Italy, Germany, and Chile).PATIENTS: One hundred forty-eight patients with acute lung injury or acute respiratory distress syndrome according to the American-European Consensus Conference criteria.INTERVENTIONS: Patients underwent a three-step ventilator protocol (at clinical, 5 cm H2O, or 15 cm H2O positive end-expiratory pressure). Whole-lung CT scans were obtained at 5 and 45 cm H2O airway pressure.MEASUREMENTS AND MAIN RESULTS: Nine patients did not fulfill acute respiratory distress syndrome criteria of the novel Berlin definition. Patients were then classified according to PaO2/FIO2 assessed at clinical, 5 cm H2O, or 15 cm H2O positive end-expiratory pressure. At clinical positive end-expiratory pressure (11±3 cm H2O), patients with severe acute respiratory distress syndrome had a greater lung tissue weight and recruitability than patients with mild or moderate acute respiratory distress syndrome (pCONCLUSIONS: The Berlin definition of acute respiratory distress syndrome assessed at 5 cm H2O allows a better evaluation of lung recruitability and edema than at higher positive end-expiratory pressure clinically set.

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